IC5b: National Registry of Certified Medical Examiners - CMV Driver Medical Examination Results

Medical Qualification Requirements

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2126-0006 can be found here:

Documents and Forms

Document Name Document Type
Form MCSA-5850 IC5b: National Registry of Certified Medical Examiners - CMV Driver Medical Examination Results Form
MCSA-5850 CMV Driver Medical Examination Results Form MCSA-5850 Form 1-8-2021 exp 508.pdf Form
MCSA-5850 CMV Driver Medical Examination Results Form MCSA-5850 Form 1-8-2021 exp 508.pdf Form

Information Collection (IC) Details

IC Title:	IC5b: National Registry of Certified Medical Examiners - CMV Driver Medical Examination Results	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 49 CFR 391.41

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	MCSA-5850	CMV Driver Medical Examination Results Form	MCSA-5850 Form 1-8-2021 exp 508.pdf		Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 65,535	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	9,708,850	9,708,850
Annual IC Time Burden (Hours)	197,448	197,448
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.